Unidentified Chronic Fatigue Syndrome/myalgic encephalomyelitis (CFS/ME) is a major cause of school absence: surveillance outcomes from school-based clinics

• Published in: BMJ open 2011-01, Vol.1 (2), p.e000252-e000252
• Main Authors: Crawley, Esther M, Emond, Alan M, Sterne, Jonathan A C
• Format: Article
• Language: English
• Subjects: Anxiety; Children & youth; Chronic fatigue syndrome; Family medical history; Health services; Hospitals; Inventory; Paediatrics; Population; School attendance; School effectiveness; Studies; Surveillance
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2011-000252

ObjectiveTo investigate the feasibility of conducting clinics for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in schools.DesignSchool-based clinical project.ParticipantsChildren aged 11–16 years were enrolled in three state secondary schools in England.Main outcome measuresNumber of children newly diagnosed as having CFS/ME.MethodsAttendance officers identified children missing ≥20% of school in a 6-week term without a known cause, excluding those with a single episode off school, a known medical illness explaining the absence or known to be truanting. Children with fatigue were referred to a specialist CFS/ME service for further assessment. The authors compared children with CFS/ME identified through school-based clinics with those referred via health services. Outcomes of CFS/ME were evaluated at 6 weeks and 6 months.Results461 of the 2855 enrolled children had missed ≥20% school over a 6-week period. In 315, of whom three had CFS/ME, the reason for absence was known. 112 of the 146 children with unexplained absence attended clinical review at school; two had been previously diagnosed as having CFS/ME and 42 were referred on to a specialist clinic, where 23 were newly diagnosed as having CFS/ME. Therefore, 28 of the 2855 (1.0%) children had CFS/ME. Children with CFS/ME identified through surveillance had been ill for an amount of time comparable to those referred via health services but had less fatigue (mean difference 4.4, 95% CI 2.2 to 6.6), less disability (mean difference −5.7, 95% CI −7.9 to −3.5) and fewer symptoms (mean difference 1.86, 95% CI 0.8 to 2.93). Of 19 children followed up, six had fully recovered at 6 weeks and a further six at 6 months.ConclusionsChronic fatigue is an important cause of unexplained absence from school. Children diagnosed through school-based clinics are less severely affected than those referred to specialist services and appear to make rapid progress when they access treatment.